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Association Between Interstitial Lung Abnormalities and All-Cause Mortality.

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Authors
Putman, Rachel K
Hatabu, Hiroto
Araki, Tetsuro
Gudmundsson, Gunnar
Gao, Wei
Nishino, Mizuki
Okajima, Yuka
Dupuis, Josée
Latourelle, Jeanne C
Cho, Michael H
El-Chemaly, Souheil
Coxson, Harvey O
Celli, Bartolome R
Fernandez, Isis E
Zazueta, Oscar E
Ross, James C
Harmouche, Rola
Estépar, Raúl San José
Diaz, Alejandro A
Sigurdsson, Sigurdur
Gudmundsson, Elías F
Eiríksdottír, Gudny
Aspelund, Thor
Budoff, Matthew J
Kinney, Gregory L
Hokanson, John E
Williams, Michelle C
Murchison, John T
MacNee, William
Hoffmann, Udo
O'Donnell, Christopher J
Launer, Lenore J
Harrris, Tamara B
Gudnason, Vilmundur
Silverman, Edwin K
O'Connor, George T
Washko, George R
Rosas, Ivan O
Hunninghake, Gary M
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Issue Date
2016-02-16

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Citation
JAMA 2016, 315 (7):672-81
Abstract
Interstitial lung abnormalities have been associated with lower 6-minute walk distance, diffusion capacity for carbon monoxide, and total lung capacity. However, to our knowledge, an association with mortality has not been previously investigated.
To investigate whether interstitial lung abnormalities are associated with increased mortality.
Prospective cohort studies of 2633 participants from the FHS (Framingham Heart Study; computed tomographic [CT] scans obtained September 2008-March 2011), 5320 from the AGES-Reykjavik Study (Age Gene/Environment Susceptibility; recruited January 2002-February 2006), 2068 from the COPDGene Study (Chronic Obstructive Pulmonary Disease; recruited November 2007-April 2010), and 1670 from ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; between December 2005-December 2006).
Interstitial lung abnormality status as determined by chest CT evaluation.
All-cause mortality over an approximate 3- to 9-year median follow-up time. Cause-of-death information was also examined in the AGES-Reykjavik cohort.
Interstitial lung abnormalities were present in 177 (7%) of the 2633 participants from FHS, 378 (7%) of 5320 from AGES-Reykjavik, 156 (8%) of 2068 from COPDGene, and in 157 (9%) of 1670 from ECLIPSE. Over median follow-up times of approximately 3 to 9 years, there were more deaths (and a greater absolute rate of mortality) among participants with interstitial lung abnormalities when compared with those who did not have interstitial lung abnormalities in the following cohorts: 7% vs 1% in FHS (6% difference [95% CI, 2% to 10%]), 56% vs 33% in AGES-Reykjavik (23% difference [95% CI, 18% to 28%]), and 11% vs 5% in ECLIPSE (6% difference [95% CI, 1% to 11%]). After adjustment for covariates, interstitial lung abnormalities were associated with a higher risk of death in the FHS (hazard ratio [HR], 2.7 [95% CI, 1.1 to 6.5]; P = .03), AGES-Reykjavik (HR, 1.3 [95% CI, 1.2 to 1.4]; P < .001), COPDGene (HR, 1.8 [95% CI, 1.1 to 2.8]; P = .01), and ECLIPSE (HR, 1.4 [95% CI, 1.1 to 2.0]; P = .02) cohorts. In the AGES-Reykjavik cohort, the higher rate of mortality could be explained by a higher rate of death due to respiratory disease, specifically pulmonary fibrosis.
In 4 separate research cohorts, interstitial lung abnormalities were associated with a greater risk of all-cause mortality. The clinical implications of this association require further investigation.
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To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.
Additional Links
http://dx.doi.org/ 10.1001/jama.2016.0518
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828973/
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ae974a485f413a2113503eed53cd6c53
10.1001/jama.2016.0518
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